September 16, 2009

Drafting young adults into any health-care reform package is crucial to paying for it. As low-cost additions to insurance pools, young adults would help dilute the expense of covering older, sicker people. Depending on how Congress requires insurers to price their policies, this group could even wind up paying disproportionately hefty premiums — effectively subsidizing coverage for their parents...

An early draft of the proposal set the penalty at $750 or $950 per year for single people, depending on income. But according to various insurance experts, even the least expensive plan under the bill could cost more than $100 per month, making it cheaper for people to pay the fine than to buy insurance.

Yes, kids, why don't each of you throw about $800 into the pot and get nothing out of it, not even any insurance. Do your part. Remember what Obama said about being responsible:

Now, even if we provide these affordable options, there may be those -- especially the young and the healthy -- who still want to take the risk and go without coverage... The problem is, such irresponsible behavior costs all the rest of us money.

There are a lot of people who are going to be surprised by the price tag -- not just young people. I have a self-employed friend who makes six figures who recently ranted about how we need health care reform because he's tired of paying so much for his insurance.

Young person: "But...but...but....if I am forced to buy health insurance how can I afford to buy booze, I-pod downloads, I-phone apps and all the other stuff on the Stuff White People Like blog . . . . My money is for buying what I want, not boring things like insurance, that is only for old people."

Everything about ObamaCare is anathema, and the "individual mandate" is right there at the top.

Government decides for you that health "insurance" is the number one priority --More important than paying rent.More important than your food bill.More important than saving for a car or a home.More important than saving for retirement.

Too bad that being forced to pay that extra several thousand dollars a year drastically reduces your standard of living, if not effectively reducing you to poverty. Too damn bad. Pay up.

That's because the media isn't reporting that young people, Obama's "richest vein of support," will be overtaxed to pay for ObamaCare.

MSNBC: "A 2008 study by the Urban Institute found that more than 10 million young adults ages 19 to 26 lack health insurance coverage. For many of those people, health-care reform would offer the promise of relatively inexpensive individual policies, which do not exist in many states today."

The media are reporting this massive tax increase as instead, an incredible opportunity for young people to get inexpensive health insurance previously unavailable!

These morons won't know what hit them until it's too late.

And it's not like they're going to vote for Republicans. That would be racist!11!!11!

TosaGuy -- Maybe you spend four to five thousand a year on booze, pot, and i-Pod downloads, but most young people have a hard enough time paying rent and student loans and saving. And besides -- yeah, it's THEIR money.

There are a lot of people who are going to be surprised by the price tag -- not just young people

Yes there are. Many of them are going to be the workers who are currently covered under their company and employer's plan. They have no clue how much the premiums are for their insurance and furthermore they don't care because they aren't paying the full load or they aren't paying anything.

The coverage for a family on CalPers Health is about $1400 a month. For other group plans where the participants are paying according to age group, the premiums are anywhere from $750 a month to $1791 for a family (Blue Shield Spectrum $750 Value Plan)

When your employer drops you because then he only has to pay 8% of payroll, a much better deal for the employer, be prepared for sticker shock. Big time.

Also be prepared to not have the choices you have now. The government wants to outlaw the less expensive, (high deductible and HSA plans) from private insurers. So you won't have a choice to go with something you actually can afford. Catastrophic coverage.

You will be forced to go onto the government plan. Or as Althouse astutely points out. Just pony up the fee and still have no coverage.

A single-payer system would make more sense, but if we're not going to have that I think this mandate/penalty makes perfect sense and is not unbearable. Middle-aged and old people obsessively complain about taxes and the weather. Young people, not so much.

"A 2008 study by the Urban Institute found that more than 10 million young adults ages 19 to 26 lack health insurance coverage. For many of those people, health-care reform would offer the promise of relatively inexpensive individual policies, which do not exist in many states today."

There is a reason why these cheap plans are not offered in "many states today" and it stems from not being able to purchase insurance across state lines. This is an easy fix that will not cost Uncle Sam a dime or mandate a single dollar from people.

Lots of folks would still not insure themselves, but those that want to will be better able to do it. Once you can bust through all the pie-in-the-sky liberal crap about "free insurance for all" that has been pumped into these young folks, this is a very easy concept for them to grasp and most will want it. People naturally understand that "strings attached" is usually not in their best interest.

I have a basic libertarian tendency, but this is pretty traditional in human society for the young to be enlisted in support of the community as soon as they are able. Usually the culture made such contribution expected and in many cases required to get the respect of the community.

In many areas, we ask much less of the young than we used too, and I think they, as well as the rest of us, suffer by creating weaker people and weaker communities.

TosaGuy -- Maybe you spend four to five thousand a year on booze, pot, and i-Pod downloads, but most young people have a hard enough time paying rent and student loans and saving. And besides -- yeah, it's THEIR money.

Flexo: State Street in Madison exists because of disposable student income.

I have a job w/o health care benefits. I don't go out as much or buy as many things as my friends with similar incomes that do.

Keith Hennesy http://keithhennessey.com/ made a good point awhile back. Even without the public option, the health care bill has a BIG problem.

He describes it as a four sided box:

1)Government qualified insurance plans will eliminate most co-pays and will require insurance to cover many conditions (some very expensive) that are not currently in most existing policies. This will drive insurance prices up.

2)Eliminate restrictions on existing conditions. Good idea or not, this too will drive up insurance costs.

3)Community ratings will require insurance companies to charge the same rates to everyone. Young healthy people will subsidize obese alcoholics with liver disease, diabetics and who smoke three packs of cigarettes a day. Healthy people will pay a lot more of the total health care costs than they currently do.

4)Mandatory coverage will give the IRS the ability to garnishee your wadges and seize your assets if you do not comply.

Something that I don't understand about this is: Since we treat everyone now, (nobody is left in the street to die), isn't the cost of treating everyone already covered by us now under the current system, even if unfairly?

Yes, kids, why don't each of you throw about $800 into the pot and get nothing out of it, not even any insurance.

By that I'm guessing you mean is that the kids won't get any "healthcare" [because they won't need it for a while]? It's not like they won't be eligible in case something does happem to them. The point has been made here before by others that "insurance" and "healthcare" are not the same. Seperate meanings of the two terms have become needlessly conflated.

Just to reiterate some things:

(1) More people should move to jsu high deductible insurance for unforseen emergencies.

(2) Responsible people will save for their own old age when they'll need more healthcare.

(3) Routine care should devolve away from high cost doctors, more into the hands of nurse pratictioners. We also need more Wal-Mart clinics, CostCo clinics, and yes, for those who need to feel special, Whole Foods clinics.

(4) Tort reform needs to be on the table. I understand why it is not, but it needs to be on the table.

Actually if you've been following the details of the debate at all (which you obviously haven't) this is exactly why the Democrats don't want to be cheap on the bill. Only Baucus wanted to be cheap, in his desperate search to please Republicans. They'll bump up the price tag and this problem won't exist. The Democrats are not suicidal.

The exact problem you describe has been debated for months in liberal blogs. That's why they prefer a $1 trillion bill as opposed to 800 billion. You obviously haven't been paying attention, because you've been focusing on the the politics of the bill rather than the details of the bill.

A public plan would also lower costs, so this problem wouldn't exist with a public plan either.

"All you need in order to be in favor of a preexisting condition requirement is to have one or know someone who does who you care about."

There are pre-existing conditions and there are pre-existing conditions. Not having insurance when you are healthy and then trying get it once you have cancer is on the individual, not the insurance company.

Build a P-EC policy that is equitable to things like genetic disorders and people who gain a condition while on insurance when they try to seek a new policy, but doesn't reward those who voluntarily gamble with their health and then whine when they lose. Then we will have a policy worthy of discussion.

"I have a basic libertarian tendency, but this is pretty traditional in human society for the young to be enlisted in support of the community as soon as they are able. Usually the culture made such contribution expected and in many cases required to get the respect of the community."

IMO, this is related to the transformation of children into pets in our non-agrarian culture. They're an indulgence.

And we keep them children as long as possible, like breeding miniature cats with round puffy faces and little nubs for ears.

And just like pets, if they work, someone will disapprove and frown and say how it's wrong for them to pull their own weight, help with groceries, or rent, or contribute in a meaningful way to family finances.

Something that I don't understand about this is: Since we treat everyone now, (nobody is left in the street to die), isn't the cost of treating everyone already covered by us now under the current system, even if unfairly?

No - people are not being treated. They are not getting any preventive care, and wait until an emergency before showing up in the emergency room. Preventive care costs money, i.e. getting a mamogram done in advance rather than waiting until your breast cancer has metastasized and you are coughing up blood.

18,000 Americans die every year because they lack health insurance. Or as I like to call it, they die because of the Republican Death Panels, that prevents these people from getting treatment in advance.

I don't mind though. I'd rather have lower taxes than let those 18,000 people live.

"And all you need in order to be against it is to understand the meaning of the word 'insurance'"

I've had insurance for most of my life, and continuously for the last 25 years. I also have a precondition, (cured cancer), but if I loose my job, and my insurance, I would become uninsurable. That seems unfair to me. Freedom is my highest value, but a lot of good that will do me, when I'm told "Yea, you did the right thing your whole life, but now you lose everything because we want out of the agreement." Kinda like gambling all your money in Vegas and then when you win big on your last dollar, they refuse to pay.

Bagoh20. I am quite willing to discuss pre-existing insurance reform for individuals such as yourself. However, such reform has to be tailored that it doesn't further incentivize/reward people for not buying insurance when they are healthy and then whining when they can't get it when they get sick.

I'm cheered. My taxes to cover healthcare will diminish from the premiums I now pay. I have a lot of insurance only because of the way its presently packaged -- a $2,000 out of pocket before insurance kicks in is hardly insurance at all. Plus all the co-pays. Medicare separate. Dental separate. Eyesight separate. Legal separate. I'll be a slight relief to have my aggregate costs diminished by spreading it out across state lines among all income earners per force of government edict. My actual healthcare will diminish too, but that's OK with me. I can do without a biopsy to take a little nick of my lung just to confirm the suspicion of some specialist. I could do without another MRI or another lower lumbar, or myelogram -- spinal tap by any name is still a spinal tap -- just to make a checkmark in a process of elimination. That tipping table isn't as fun as I thought it would be, with your bare ass sticking up and needle in your back with someone else at the control panel.

The new taxable generation will not learn anything.

They were born into an overly regulated world. They think government is the answer to the problems, not the source of the problems. They honestly believe the cause of the problems is de-regulation that cause wild market fluctuations and wealth grabbing.

The very word "regulate" is distorted over time through the mouths of politicians to mean the exact opposite of its origin. "To make regular" now means "fiercely control irregularly."

I say, "Good." This is what misplaced loyalty to political party gets you. Voters again failed to read politic-speak correctly. It would be helpful if listeners would interpolate every single sentence to understand the exact opposite of each expression. So that, "Nobody making less than, say, $250,000 annually will be taxed at all" means, "We intend to tax the living shit out you so thoroughly but we'll call it something else so that you won't know you're being taxed, in fact, we intend to make you vassals of the state."

All health insurance needs to be untied from the employers with the tax break given to the individual. Eliminate bans from buying insurance across state lines. Allow true private health care cooperatives (no gov't involvment, period). Mandate if a person can show continuous insurance then they can not be denied new coverage due to a pre-existing condition. Insurance companies cannot deny coverage for pre-existing conditions for anyone under the age of 21.

Since you buy your policy, it goes with you regardless of employment status. The number and variety will be higher due to open state insurance borders. You get to buy insurance with pre-existing conditions before you hit 21 (or pick another age). This will allow for genetic and childhood conditions. Once insured by age 21, you cannot be bumped for PE-C if you continuously maintain a policy.

Okay, its an idea that I am sure will be picked apart. In my opinion it blends freedom, individual responsibliity and social responsibility. It also keeps out excessive layers of gov't

No - people are not being treated. They are not getting any preventive care, and wait until an emergency before showing up in the emergency room.

Plenty of people do this even though they have insurance. TennCare was supposed to empty out the hospital ERs by making people pick primary-care docs and go to them. But people don't necessarily do what you or I think they should.

When you see a systemic problem, stinginess on the part of the right not wanting to pour money on it isn't necessarily the root cause.

There is a new book describing the Democratic Party’s libertarian roots and how they switched from Jefferson and Jackson to Rousseau and Marx in the 20th century. You’ll find it on Amazon Books under Clay Barham or on the website www.claysamerica.com. Now you can see Obama's basic "roots." It will help you understand how he arrives at his positions.Clay Barham

Goals:(1) Drain all money now under the control of private American citizens,(2) nationalize and shut down lending by the banks that have power to loan more money at leverage,(3)Announce the New World Money issued under UN regulated Treaties,(4) collect all money left in American hands to pay Hoax CO2 crisis taxes, and (5) cut American military spending to levels we can pay for as we go. Those goals are someones goals and they are being carefully aimed at as we speak. Will President Obama resist them or push for them? That is the only question. Whether Obama is Black, White, Brown, or Yellow is not the relevant question.

Unlike Social Security, however, making everyone get insurance has two *potential* upsides: (1) making all people buy insurance may lower overall costs, even looking at each individual, since having more people decreases risk, and especially when looking at the cost of giving emergency care to the poor [those who can't afford it], and (2) it's making people pay for things that they may not want, but at least it forces them to get a benefit now, rather than a potential future gain. [This ignores AA's point on some paying the fee and not getting insurance anyway.]

This goes against two main downsides:(1) The government may do this badly and inefficiently, as compared to private insurers, and (2) The government may make decisions for us that we don't want, like insure illegals or make me get insurance when I don't want to.

It's like the mob. You have to pay protection money so the government will take care of you. But, if you don't, you still have to pay, in this case, fees rather than poundings or harassment, though you might receive poundings and harassment if you resist taking your lumps like a good citizen.

Kyle said: [This ignores AA's point on some paying the fee and not getting insurance anyway.]

If that's what she meant (and Althouse should clarify), it's not like those young healthy people aren't going to get treated in the unlikely event that they require hospitalization.They may choose to take the fine, not get insurance, get in a car wreck and still get treated. And I'm all for that.

I've had insurance for most of my life, and continuously for the last 25 years. I also have a precondition, (cured cancer), but if I loose my job, and my insurance, I would become uninsurable. That seems unfair to me

And so it is. But it isn't any reason to completely ruin the entire industry of health insurance and destroy the coverage of millions of other people.

There is an easy fix for your problem that doesn't require draconian measures. Create a health portability act that allows you to get alternate coverage, without consideration of the pre condition, within a reasonable time frame of losing your job. And with the condition that there hasn't been a break in coverage.

Not exactly like COBRA which only allows you to continue with your employer's plan for a limited time, but real alternative coverage.

It would be easy and logical.

Of course that wouldn't suit Obama, who wants to shake up the entire system, level the playing field, destroy private health insurance and take control of the industry

1. Nobody complains that it is mandated that we all have auto insurance if we drive. We are not allowed the option of paying out of pocket if something happens.

2. There are not enough doctors and nurses to provide all the care which the uninsured supposedly do not get. In addition, our ability to expand medical school class size is limited, and the nursing situation is devolving as we speak. Additionally, the average age of Nursing Professors is something like 57, which means there will be an inadequate supply of instruction to meet any attempted increase in the number of students.

You are only required to buy liability insurance and then only if you own and operate a motor vehicle.

You are not required to buy collision or comprehensive or accidental injury, and have the option of paying for those out of pocket, and you are not required to buy insurance at all if you do not own and operate a motor vehicle.

The auto insurance example is a red herring. Simply because I have and use a living body is not justification for mandating that I insure that body.

Tosaguy, I love it. It's exactly what I have been thinking. I hope somebody does chime in and tell us what the problems are.

(Posted my previous response to you before reading Tosaguy.)

I like it too. As a licensed financial advisor/planner and insurance rep, I only see a couple of problems that have to do with the tsx credits.

Since many people don't pay taxes I would object strenuously if the 'tax credit' were to result in a cash rebate. A 'tax deduction', meaning a deduction from the gross income on which the taxes are to be paid, might be a fairer system.

I would certainly make available high deductible plans, since the premiums on those are much less. Frankly, most people don't need to have low deductible plans and are more adequately suited to only cover the most catastrophic occurances. It is called risk management.

I also think that to maintain coverage after developing a serious pre-condition, that would make you ineligible for insurance as a new applicant, the insured would have to show that there was no break in coverage. Or that the break in coverage was minimal. No more than 6 months. Not all preconditions are such that they deny you coverage. They just make the premiums more expensive. Such is the nature of insurance.

I have been chuckling about this for a long time, as the generation who gets their "news" from John Stewart and who really put Obama in the White House and as a side benefit, gave the Democrats their big majorities in Congress is the exact same generation that will end up getting hit the worst by this, except maybe the frailest seniors.

How do they get screwed by the Democrats here:- No more free riding - they now have to pay for health insurance, even if they don't need it, and most at least of the guys don't unless they do something really stupid.- Elimination, or severe limitations on age ratings will hit them the worst. Ditto for community ratings on health. Even limiting the age rating to 2X will hurt them a lot. My guess is that the actual ratio right now is better than 5x.- Minimum wage increases. Yes, they were in the works before, thanks to the Democratic majorities over the last couple years. But now they are hitting, trying to make up for a Republican majority in Congress for most of the preceding 12 years. And the primary victims are the late teens and early 20s who are just entering the work force.

We all sometimes would like to be young. But maybe not now. They gave us this mess, and will be paying for it the rest of their lives.

1. Nobody complains that it is mandated that we all have auto insurance if we drive. We are not allowed the option of paying out of pocket if something happens.

As noted, you can't opt out if you won't want health care. Plus, auto insurance is probably even more closely tied to risk than is health insurance. Those who are the riskiest pay for it, and those who are the safest don't. This won't be the case with Health Care/Insurance reform. There, we will have massive cross-subsidization of the young to the older and the healthy for the sick.

This goes against two main downsides:(1) The government may do this badly and inefficiently, as compared to private insurers, and(2) The government may make decisions for us that we don't want, like insure illegals or make me get insurance when I don't want to.

I think that you are optimistic to use the word "may" throughout that. The more appropriate word is "will".

After my 2 daughters graduated from college, I insisted they procure their own insurance. I made the case that by becoming uninsured, they were actually risking MY financial future, because I, as a concerned parent, would do anything within my economic power to make sure they got the medical care they needed if a problem arose. They both got HSA policies with high deductibles for something like $70/month. The policy covers a physical annually. I told them I would underwrite the $5000 deductible in case of a catastrophic illness or accident,and I sleep much better at night knowing my liability is limited to $5000 for each of them. It has worked out fine so far. However, NONE of their friends carry coverage if it is not available through work, which happens less and less often. It is not too big of a financial burden - they just don't see the need. One friend was just hit and run while riding his bike, woke up after surgery in the hospital, uninsured. That was sobering but I doubt many of them will take steps to change unless it is mandated. Youth - a mix of carelessness and laziness.

Unlike Social Security, however, making everyone get insurance has two *potential* upsides:(1) making all people buy insurance may lower overall costs, even looking at each individual, since having more people decreases risk, and especially when looking at the cost of giving emergency care to the poor [those who can't afford it], and

Highly unlikely, despite the blathering to the contrary by the liberals here. The government doesn't make anything cheaper or lower overall costs.

You are welcome to suggest places where it has, but I think we can find numerous contrary examples for every positive one that anyone here can find.

(2) it's making people pay for things that they may not want, but at least it forces them to get a benefit now, rather than a potential future gain.

I am not sure what you mean by a benefit here. Yes, their emergency room visits will now get paid for by insurance, but that probably means by the American taxpayers, since these added costs (along with minimum wage increases) are going to force any number of the working uninsured out of work.

Meanwhile, Amy, for every such person that is injured without insurance there is 99 who are never injured.

I went about 8 years without insurance. I needed to go to the doctor only once, when I got strep throat, and I paid for that office visit out of pocket.

I've had work-provided insurance now for 10 years. Last year, the total premium, as paid by both me and the employer, was over $5,000. Meanwhile, my total burden on the healthcare system was about $10, which was to purchase some ibuprofen out of pocket. Likewise the year before, and the year before that.

Don't worry, there are plenty of people now who are insured but so healthy that they never use their benefits, such that they are subsidizing everyone else to the tune of thousands of dollars a year per person.

Force more people to buy "insurance" you are going to end up with more people seeking actual healthcare treatment, more people going to the doctor, in order for them to get their money's worth. You are not merely increasing the supply of funds, you are increasing demand. That does not result in any ultimate savings whatsoever.

Flaxo - good for you, but if you'd had the poor fortune of getting cancer instead of sore throat we'd all be paying for your treatment. And that's the point -- uninsured healthy young people all face risks that are going to fall on some of those uninsured young people. Why should the uninsured young people not bear the cost of that risk they face? All the rest of us with health insurance do?

Nice try Anne, but I'm young, super healthy, and super psyched about getting health insurance for $100 a month. As are all of my friends.

Hahahahaha

Good luck with the bargin $100/ mo. Also good luck with the giant increase in your tax bill along with the hyperinflation caused by all the money printing reducing the value of money so that a single banana will cost $5.00 and your cup of Starbucks $10, all to pay for the $2 trillion bill.

I don't know that it is true. I'm not really even seeing anecdotes about suffering because of the lack of government management of the health care system/lack of insurance.

Can’t vouch for the 18,000 figure, although I have heard it asserted elsewhere. It seems by its nature to be some sort of estimate extrapolated from other data.

If you accept this premise: that artificially reducing the cost of breaching an insurance contract will lead to more breaches, and resulting denial of care, then here’s an anecdote for you. There’s lots of other similar ones.

Don't worry, there are plenty of people now who are insured but so healthy that they never use their benefits, such that they are subsidizing everyone else to the tune of thousands of dollars a year per person.

I used to be one of those people. We are wising up, and that's part of the problem for the system.

"If we as a society want to help people with pre-existing conditions, then the best way to do so is to allow those people to sign up for Medicare or Medicaid."

In other words, provide to this sub-population what is called universal health care, or single payer, in other systems. I'm all for that, and not only because I also have a pre-existing condition, actually, several: cured leukemia, surgical removal of skin cancer, hospitalization for pneumonia. Bascially, anyone who has ever been sick can be aribtrarily determined to have a "pre-existing condition" sufficent to render one unacceptable to buy private insurance, or even to to have an existing policy nullified, despite the premiums one might have already paid. Fortunately for me, I have a job that provides me with insurance, but if I lose this job, I'm fucked. (By the way, it's not just about "helping other people" but about our helping everyone, including ourselves.)

"Forcing insurance to do what it was not designed to do will only make it more expensive for everyone, which makes it less attainable for everyone."

All the more reason to dismantle the health insurance racket once and for all, and provide access to health care to all Americans, to be paid for, as are our public utilities, roads, schools, police forces, fire departments, etc., out of our taxes.

Fortunately for me, I have a job that provides me with insurance, but if I lose this job, I'm fucked.

Unless your work for the government or a church, your job does not provide you with insurance. It provides you with a piece of paper conveying an unenforceable promise that some insurer will provide medical benefits if it feels like it, and if it doesn't feel like it there's precious little you can do about it.

All the more reason to dismantle the health insurance racket once and for all, and provide access to health care to all Americans, to be paid for, as are our public utilities, roads, schools, police forces, fire departments, etc., out of our taxes.

And what a sweet deal for the 46 millon or so people who don't pay any taxes.

Amy, I nagged other students in grad school who didn't have insurance. One guy told me that it was OK, he could just use medicaid. I told him he was nuts if he thought his mom and dad wouldn't mortgage their house to get him good care.

I tried and tried to get the young woman who taught my aerobics class to get insurance after she graduated from college. I even got her brochures showing plans for $60/month. Oh no - she had a job and her insurance kicked in after three months.

Two days before her insurance started, she went to the ER in awful pain. Ovarian cysts. $10,000. She had to use the money she had been saving for her wedding to pay the medical bills.

"Don't worry, there are plenty of people now who are insured but so healthy that they never use their benefits, such that they are subsidizing everyone else to the tune of thousands of dollars a year per person."

Virtually every one of those people will get seriously ill or die suddenly. It's really one or the other. So, those healthy people are subsidizing their own eventual costs not others. Of course if they don't get coverage until late in life they are ripping off the system. Unless they promise to off themselves suddenly.

"And what a sweet deal for the 46 millon or so people who don't pay any taxes.

Woo Hoo free ride!!!"

Assuming this number of people who allegedly don't pay taxes is even close to the reality...so what? Do we prevent non-taxpayers from driving on our roads or over our bridges, calling for help from the police or fire departments, their children from attending our schools?

The real free riders are the corporations who pay minimal or no taxes, thus shifting their rightful share of the tax bill on to the American people. Corporations want the rights of citizens under the law, but they want to avoid the concomitant responsibilities.

"'Access to health care' under single payer systems has always meant the ability to wait in long lines or be refused service altogether."

Says who? Of course this is the propaganda promulgated by those who oppose such a system being implemented here, but, while no system is perfect, there is no evidence of any statistically significant number of citizens in either Canada or the UK who would even consider trading their systems for ours.

And since when has American health care delivery been free of waiting to be seen or even outright denial of care? Denial of care is how the insurance companies make their profits!

"no evidence of any statistically significant number of citizens in either Canada or the UK who would even consider trading their systems for ours."

That's a statement devoid of any meaning. I mean, so what?Since NHS and Canada Medicare patients have been captives of a socialist system for more than a generation, how would they have any idea what they were comparing?

The perennial congressional incumbency proves that "the devil you know" is usually much preferred over the unknown.

The fact that you don't know about efforts in the NHS and Canada to whittle down there huge wait lists over the past 10 years is testament to a refusal to address a concern that has been repeatedly written about in the US and the affected countries for that same interval.

That's complete nonsense. Insurance companies make their profits the same way ALL insurance companies make their profits: by charging people more than the average payout. The small fraction of people who incur large medical expenses are covered by the people who don't. It is the same way the government will run things, except that it is voluntary rather than enforced via extorted tax money and threats of physical violence.

"The real free riders are the corporations who pay minimal or no taxes, thus shifting their rightful share of the tax bill on to the American people."

Really? You think corporations ever pay taxes. Only people can pay taxes through sacrifice of time, labor, savings etc. Corporations just pass it through no mater how much you tax them. Taxing corporations just kills jobs, since it discourages people from using them and thus creating vehicles that hire people and take advantage of division of labor and other great ideas we have thought up over the centuries, but go ahead kill that. Good progressive thinking there.

Please explain it to those oh-so-wise and "compassionate" people who think that they, with the government, can dictate to others how they spend their own money, i.e. force them to buy "insurance" they otherwise would choose not to buy.

The real free riders are the corporations who pay minimal or no taxes, thus shifting their rightful share of the tax bill on to the American people.

If I'm reading Table II.1 here correctly, the US actually has the highest average combined (federal + state) corporate income tax in the entire OECD. The US also has the most progressive individual income tax structure in the OECD. Thinking about this recently, though, I realised that these two may go hand in hand.

Corporate taxation is highly regressive, in that the burden of corporate taxation will tend to fall on the corporation's customers and -- to a lesser extent -- on its workers and shareholders. That is to say, it's essentially a consumption tax, but unlike other consumption taxes, which may exempt certain essential goods poor people need for daily life, the tax will flow through to pretty much anything and everything the corporation makes, if it doesn't push wages down (or employment, since wages are sticky), or reduce earnings.

I suspect a model of US taxation that took into account the regressive effects of corporation taxation, our tax system would not be nearly so progressive as it appears at first glance.

Revenant said:"'Denial of care is how the insurance companies make their profits!'

That's complete nonsense. Insurance companies make their profits the same way ALL insurance companies make their profits: by charging people more than the average payout. The small fraction of people who incur large medical expenses are covered by the people who don't."

See, people keep posting stuff like this and I have to be a blog pimp and broken record in response. The fact is, respecting employment-based insurance, which is by far the most common type, insurance companies make (more) money by denying valid claims. Given that the law affirmatively encourages them to breach their contracts that's what you would expect.

@garage - If it's the same crap monopoly that exists today, yea. Which is the gift Baucus wants for his clients, the insurance companies.

Baucus's just released "draft" proposes to raise $214 billion through a 35 percent excise tax on high-end insurance plans and assessing $93 billion in fees on device manufacturers, insurers and clinical laboratories, and making a series of tax code changes.

He's back-dooring policy holders.

Common sense tells one that if you raise the cost of a premium by 35% that a percentage of employers/policy holders will choose a lower cost plan and as the pool diminishes the insurers will drop those plans, resulting in less tax revenue.

Does he really think Americans are that stupid? I can't imagine that unions are going to be happy as they have traded off wages for the so-called "Cadillac" health plans.

Why is it that every time the Dems aim for the "rich" they hit the middle class in the wallet? I'm beginning to suspect their lousy aim isn't accidental.

I don't know how you can convince lefties or even most people that profit is good. Everybody seems to understand it when they make the profit themselves. But, everyone elses profit needs reduced. They want that subconsciously so that they can increase their own wealth, whether they notice that is their motivation or not.

I spoke to a young man who lived in Soviet Russia when he was a kid. He remembered the food shortages. Since he now lives in America, he was very very concerned about Obama's socialist tendencies and associates.

"Rejection of care is a very lucrative business for the insurance giants. The top 18 insurance giants racked up $15.9 billion in profits last year."

The "key sentence" is a direct quote from the press release of a self-described "leading national advocate for universal healthcare reform". No supporting evidence for the claim is provided in the press release.

Most importantly, we aren't told what the gross revenue was that yielded that $15.9 billion. If that was on $50 billion of revenue then, well, that's quite good. If it was on $500 billion it is terrible. $15.9 billion is a scary number. Not as scary as the $900 billion Obama's plan will start off costing us, but still pretty scary. But to really know how scary, you have to compare it to revenue.

Do we prevent non-taxpayers from driving on our roads or over our bridges, calling for help from the police or fire departments, their children from attending our schools?

Well, with the exception of the schools, we don't force them to use those services either. I don't use those servces, yet I pay taxes for them. Other people do use the services and don't pay. Someone is getting a free ride.

Those items are all public works and legitimately subsidized by government/aka the taxpayers. However, forcing people to buy insurance or in this case forcing people to buy OTHER people's insurance is not a function of government.

The choice on whether to insure or not insure is a function of rational risk managment, be it life, fire, auto or health insurance.

If a 25 year old guy who has no assets to protect or dependants that he cares about and decides not to purchase life insurance and decides to put the money into a savings or investment account instead.....THAT is a rational risk management decision.

Same thing goes for health insurance. A healthy young person who doesn't have a family history of illness would be rational to not put money into health insurance and instead put it into savings or buy an accident policy.

If I'm driving a 12 year old car, I would be foolish to buy collision and comprehensive insurance, when the required liability insurance is all that is needed. The value of the car is nil compared to the cost of premiums and the time value of money dictates that I invest my money in other areas.

Risk managment is all about deciding which risks you want to bear yourself and which ones you want to pay to have insured. The least likely risks or the less expensive risks don't warrant insurance.

None of those decisions are the government's business. And it certainly shouldn't be MY responsibility to buy those things from my taxes for other people who don't pay INCOME taxes.

Revenant said..."'See, people keep posting stuff like this and I have to be a blog pimp and broken record in response.'

Don't apologize. After all, it makes it easier to ignore you when you admit up front you have nothing to contribute to the discussion."

Fair enough. Your response to that comment of mine is understandable. I just think we overlook a very very important issue if we "reform" health insurance while leaving in place insurance companies' absurd immunity from any consequences for bad behavior up to and including fraud, and act as if that won't influence their behavior. Perhaps you don't believe that is what is going on (the disabusing of which is the point of linking to my ERISA-reform blog) or you think it's a good thing (in which case I would be interested in learning why).

No, it's not unfair that some or even all companies don't cover preexisting conditions. What's unfair is the ridiculous proposition that such companies should have to cover you. Let's say, for example, that I have no insurance and a condition that says I'll have about 10 months to live and about $2 million in medical bills (for stats people, say that's the average and there's some variation around there, like by 25% evenly in both directions, to take into account some risk).

It makes no sense to allow that person to be treated like healthy people. He should pay $200k a month (plus overhead) for insurance, because that's the rational decision.

To be clear, I'm all about having people with preexisting conditions have insurance, but they have to pay for that. Either you pay for health insurance from the beginning or don't get insurance and take the risk of getting a condition.

No backsies.

(I think I'd be in favor of a gov't run program to insure kids before they can get their own insurance - otherwise, a cancer kid who lives would get screwed by having bad parents. I liken that to illegitimacy being a quasi-suspect class. After that, there are programs to get you across patches when you don't have a job, like buying your own damn insurance.)

Opportunity cost is the lost opportunity or return on your investment from one investment or action over another.

In my business, securities and financial planning, the lost revenue you might get from not investing in the safe investment in exchange for a larger potential return in a risky investment. For example buying stock AAA that yields a 2% dividend in the hopes that the stock itself will grow by 10% instead of a safe bond that pays a 5% coupon. The opportunity cost is 3%. You gave up the opportunity to actually earn 3% more for the opportunity to possibly earn more on the stock.

This is different than the time value of money. Which considered the present value of the money versus the future value. A dollar received today is worth more than a dollar received in two years because the dollar today can be invested and will be worth more in two years.

Time value of money and opportunity cost dictates that, unless you have a rather certain risk that needs to be managed, your money is better invested rather than spent on insurance. However, risk management dictates that if you do have a risk, like a bad heart, have a home in a high fire area, drive an expensive car on the LA Freeway, your money should be spent on insurance now and not to bother with the opportunity cost or present value of a future investment.

Perhaps you don't believe that is what is going on (the disabusing of which is the point of linking to my ERISA-reform blog) or you think it's a good thing (in which case I would be interested in learning why).

I don't doubt that ERISA has contributed to the problem. I think we may differ on the mechanism for the biggest problem there though -- I expect that incentivising systems where employers choose what insurance policies their employees can buy is not really in the best interests of the employees, and simultaneously increases the baseline cost level. Sort of a worst of both worlds.

Employees choosing and paying for their own health insurance would have reason to look at provisions on recission and check for, e.g. mandatory arbitration provisions, or provisions limiting the availability of evidence in actions challenging denial of coverage. He also has an incentive to comparison shop -- see what carriers have a reputation for unjustified recission, etc. etc. Because it's their health care, after all. It's not the employer's. An employer just isn't going to be incentivised to look out for that kind of thing the same way the health insurance beneficiary is.

At the same time, though, I suspect employers are much less price sensitive to the cost of health care than employees are. Employers provide perks or benefits that many employees -- if they had the choice -- would probably be happy to trade in for extra cash compensation. The clearest example of this is probably business class air travel. You'd have to be pretty rich not to be willing to trade in a $10,000 business class seat for a $1,000 economy seat and $9,000 in cash. Business class air travel is an extreme (and somewhat unique) example of this trend, but I think that in general, businesses are less price sensitive than employees, which has the effect of reducing downward pressure on prices in the health insurance market and -- through the health insurance market -- on health care itself. I don't doubt that a market much more heavily biased towards individual purchase of health insurance would still be facing runaway health care costs. But I think the natural baseline from which it started would be considerably lower.

So I think severing health insurance from employment is potentially quite important for developing a more effective market in health insurance. And I don't think I'm alone in thinking so. If we could do that, ERISA, HIPAA, COBRA health care provisions, and all those weird legislative kludges that have evolved in connection with employer-provided health care would (hopefully) fall by the wayside.

Of course, the House bill is designed to achieve precisely the opposite effect -- businesses which fail to provide health insurance for their employees are going to be slammed with, as I understand it, an 8% payroll tax.

One thing to keep in mind with insurance companies denying coverage is that it rarely affects those in individual plans, since they can get punitive damages, and it often doesn't affect big companies or big labor either, since they have bargaining power enough to keep it from happening.

"For all cancers combined, 5-year period survival estimates for 2000–2002 were much higher for the American were much higher for the American patients monitored by the 14 cancer registries in the SEER programme than in the 47 European cancer registries included in the EUROCARE period survival analysis". source.

So, if we go to an NHS-style single payer system, 5 year cancer survival rates for women would drop from 62.9% to 51.4%, attributable largely to fewer CT and MRI machines, and some differences in chemo available.

By 1990-94 data, there were some 1,111,000 deaths in women from cancer. A decline of survival of 11.5% would result in perhaps 128,000 additional deaths.

If I had a nickel for every boomer lefty turned conservative in later years, and ripped on gen x, I'd have 5% of my promised ss check.

And, if you rip on us for being spoiled because we always "won" at soocer, kids didn't make the rules! You did because no one ever loses in life according to your old views. 2016 the shit hits the fan when my fellow "idiots" realize it, and they become you...and you"re 70 and retired.

There is a 37 trillion dollar (and growing) gap between funds to pay for Medicare and present unfunded obligations.

The two most logical sources of funding are the young and middle-aged who want a free or low cost ride in their working lives...and the elderly, who consume far more than they ever paid into the system then want freedom from all bills or assessments on their estate to recoup the losses America currently absorbs.

Meaning that we may have to both tax each younger American more AND resume the Death Tax to assess elderly for the gap in what they paid in and what they cost the system in the last years of their lives.

Not popular, but that 37 trillion is a cold, hard, unavoidable figure...

Of course that can be ameliorated somewhat by other cold, hard decisions to cut costs down to what France, Germany, and Japan manage without any medical bankruptcies, while maintaining higher quality of services and having citizens with longer life expectancies than America has. That would be about half the US per capita cost, while covering everyone. But they still require a higher burden on people paying in during their productive years, and have estate taxes....even while they hold down costs to less than half of what the US gets.

Cedarford - that $37 trillion of unfunded liabilities is nonsense. The fact is Congress can choose any year to cut back on entitlement programs. There are no liabilities beyond the immediate fiscal year.

Ain't it awful that 46 million Americans are uninsured? Oh, wait, 10 million of the 46 are here illegally and we're not going to cover them (because we already do b/c they're not turned away at the ER) and at least 6 million are irresponsible young adults who choose not to buy insurance. Hence, the 30 million Obama spoke of in his address to Congress.

You don't think the private insurance system works this way? 21 year old kid breaks his arm, actual payout: $8000. 61 Year old man get's chemotherapy - payout: $88000. The 61 year olds premiums are not 10 times higher with his insurance - insurance is a ponze game no matter who's paying. We could go forth and compare and contrast the "death panel" concept, "rationed healthcare", etc, etc. ALL of the worst things you've imagined about a public system are ALREADY HAPPENING. YOU"RE ALREADY PAYING FOR IT TOO.

It's as though most people have never even thought of how the current system is working. What surprises me most is how as people are figuring out each step of the game, private or public, that they have to exclaim their viewpoints with grandeur and explicatives. The most depressing part of this whole health care debate is witnessing the presently tragic outcome of the modern American education system.

It's indicative of how perverse Americans are that we--well, many of you, not me--wet our diapers over the supposed theft of our tax dollars to pay for health care for all that would save lives and alleviate misery and ruinous financial burdens on sick people and their families, while cheering on the squandering of trillions of our tax dollars to murder and torture and maim innocent people in other parts of the world.

This can't only be ignorance; there's an ingrained brutality and inhumanity in us that belies our own self-flattering national myths.

It wouldn't be wrong to oppose "free health care," it would be plumb stupid! But who's talking about "free" health care? Single payer health care would be paid for...by all of us through our taxes...just as we all pay for the bombs and bullets presently killing human beings abroad. Our wars aren't free, either!

Well...there is no talking to the willfully obtuse--witness the Tea Party crowds, mostly uninformed Glenn Beckian nitwits--but no; I just won't try to offer a riposte to your previous failed witticism. I'll continue to respond where an intelligent comment is needed and where I have the time to contribute.

I'm glad you are able to read the minds of the 7,000 people at the Tea Party events -- all controlled by one man, Glenn Beck, who manages also to get the President to abandon his loyal friends Van Jones and ACORN.

Me, I'm not able to read the minds or motives of people. I'm just ordinary, I guess.

Now your poor cousins in the UK we don't seem to have a health insurance problem - we may have a problem with how it's used - but when you get ill NO ONE WORRIES HOW THEY'RE GOING TO PAY. That doesn't mean they don't pay, since 1948 that there is a compulsory national insurance contribution paid by employee and employer, amount depending on earnings & for most people deducted from salary before you get it. RESULT? End of civilisation? Britain run by commies. Don't think Maggie Thatcher was one of those. Now the conservatives here vie with labour to say how they love the national health system, how they will protect it the best etc.

This healthcare means that we are paid up whenever we go to our doctor or hospital, everyone gets treatment. If we have a prescription from our doctor, the most each item will cost is around £7.50. If you are on various pensions, welfare, or low wages, you don't pay.

Take me - at 64, on drugs for blood pressure, hypothyroid and chol. for life, annual check ups, no cost. Recently other medication for a skin condition. No cost. Then my practice sent me to a physio recently for a shoulder problem. No cost.

One of my best mates had testicular cancer 25 years back, surgery and chemo. Been in remission since. Now has lung cancer (life ain't fair), so far 2 courses of chemo, best consultants, home support, pain relief. No cost.

My son - attacked 12 years ago by a drunk with a hammer, smashed his leg, 12 months unable to walk, cutting edge micro-surgery at a local hospital. Two grandchildren - no charges for births in hospital. Maternity care, health visitors, and much else.

How do we do this? Again, all within a national insurance scheme which funds the national health service. Why do Brits want it (please never believe the politicos who tell you how bad it is, they have a motive other than my well-being). Because it works, it can be improved (what can't) and no one wants to return to 'the good old days' which ordinary families here have very bitter memories about.

You have never had such a system, so all the ravings we read in US blogs have no check with a reality we see daily. We love to grumble of course, but that's our privilege as free people. When Brits fought Hitler, we were asked what sort of world we wanted after the war - this was what came out top, and people often say it was the best thing to emerge forus ordinary folk.

By the way, any health care insurance system always means the younger workforce helps pay for the retired etc. Very few people here ever resent that - it's nothing to do with being commie to agree we help the old, the poor, the very young, the vulnerable. It's to do with basic decency 'honour thy father and mother' and all the rest.

What we all say here, when we are ill or old etc - "I paid all my working life into national insurance. Some of my earnings have gone into that just for this occasion."

Whatever you do, it does seem to me you face the same issues about what makes for a decent society. We know this works, it ain't paradise, but you won't need healthcare there I hear. Until then, we love our NHS even if we have to wait sometimes, and there are foul-ups, and so forth.

Get the facts. It would be a good idea for everyone to contribute their share including youth especially if they expect their parents to be able to subsidize their education so they can have a secure job future, or if they want to preserve any possibility of inheriting their parent's wealth. Without reasonable sharing of costs among youth and older adults the youth can look forward to a heavier burden when they are left broke parents. Highly doubtful that the youth of the Obama generation would toss their parents aside to pull themselves up by their bootstraps when they are elderly and frail....unless they become misled/ disillusioned by your fear stimulus package. If you want the truth on who would be most burdened and if you want to know how we can minimize unfairly burdening segments of the population